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It's Time to Decide on Treatment: Stage 1b, 100% EC

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  • #16
    Originally posted by biwi View Post

    Confirmation bias is definitely a thing here on this forum.

    The other reason why centers generally prefer surveillance is because they are working to reduce statistical over-treatment. A person who elects to go on surveillance instead of 1xBEP and then needs 3xBEP is not considered over-treated by 2xBEP. However, a person who does 1xBEP who actually was part of the portion that was already cured, is considered over-treated. Correspondingly, if the percentages receiving adjuvient treatment are greater than the chance of recurrence that population is statistically medically over-treated and some received unnecessary treatment. That, combined with the fact that once on regular surveillance, relapses are caught quick enough to be low to moderate stage and have very high probabilities of being cured by 3xBEP/4xEP, give Dr. E the assurance that he is not reducing patient's chance of cure by recommending initial surveillance.

    I agree.
    Last edited by ByeByeMrRighty; 12-22-17, 07:11 AM.

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    • #17
      The second oncologist I met with today was pro-RPLND for my stage 1b EC case, whereas the first oncologist I met with didn't see it as an option. The more I research this stuff, the more I find opinions differ even among the most experienced doctors. It's a bit unsettling.

      ----- Is RPLND an option for early stage 2 disease should I stick with surveillance and relapse? I know it is by know means standard, but one study I read reported RPLNDs in stage 2 cures about 2/3rds of cases. For the other 1/3rd, BEP x3 follows as normal (post-RPLND).

      "Primary RPLND cures 70% of patients with pathologic Stage II disease and the 30% that do relapse remain curable with three courses of chemotherapy."

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3392487/

      ----- I'm also curious to know in what percent of cases an RPLND is necessary following BEP x3 because of teratoma or other suspect masses? I know EC tends to transform...
      Last edited by ByeByeMrRighty; 12-22-17, 07:12 AM.

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      • #18
        You have doc E's opinion. There is no one better qualified to assess you case.My question now is why are you trying to second guess him? You have the opinion of the doc that developed 3xBEP. Are you the sort of person that will find surveillance difficult? Do you think you'll worry a lot going into surveillance appointments? If that's you, than consider 1xBEP. I, Personally, would not consider RPLND with EC. I would be concerned about the chance of missing micro mets to other areas.
        Dave
        Last edited by Davepet; 12-23-17, 02:57 AM.
        Jan, 1975: Right I/O, followed by RPLND
        Dec, 2009: Left I/O, followed by 3xBEP

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        • #19
          Originally posted by ByeByeMrRighty View Post


          I agree.
          Originally posted by ByeByeMrRighty View Post

          Understandable considering you relapsed as have many others on this forum, but I think it's important to understand confirmation biases at play. This forum draws the people that relapse and the ones who don't never post here.

          50% chance of recurrence is 50%. Those are relatively okay odds to avoid treatment all together. And when people like Dr. Einhorn, who was a pioneer for bringing chemotherapy to the forefront, recommends surveillance for allstage 1 patients, I take that very much to heart although I know it's no guarantee. He understands the nuances we might not. As for pure EC, stage 1a and 1b aren't tremendously different.

          Suggest to go adj chem for stage1b
          Suggest to go surveillance for stage1a

          The reason of my suggestion is based on the multivariate analysis which tell the difference between 1a and 1b. Article Link:

          http://ascopubs.org/doi/full/10.1200/JCO.2013.53.5831#

          Surveillance for Stage I Nonseminoma Testicular Cancer: Outcomes and Long-Term Follow-Up in a Population-Based Cohort

          Gedske Daugaard, Maria Gry Gundgaard, Mette Saksø Mortensen, Mads Agerbæk, Niels Vilstrup Holm, Mikael

          However, if you still think that I have confirmation bias, please ignore this article and do not need to reply my message.
          30/12/16 2.5cm on right testis, 6mm on left testis.( B-HCG 0.34 <2,AFP 4.5 <7)

          24/01/17 Right I/O
          (Pure embryonal carcinoma, no lymphovascular, no invasion of tunica albuginea, rate testis, epididymis, spermatic cord. )

          14/02/17 AFP 2<7, 6mm on left testis
          17/02/17 Survelliance
          06/03/17 CT scan (Visible lymph nodes in the mediastinum . probable benign reactive appearance)

          28/07/17 AFP 35 (normal 7), relapsed confirmed
          04/08/17 CT scan (new metastatic para-aortic lymph node 1.6cm AP1.5cm)
          10/08/17 Start 3 BEP, AFP201 (normal 7)
          06/10/17 End of 3 BEP, AFP3 (normal7)
          17/10/17 CT scan
          27/10/17 Prev left para-aortic lymph node not seen. AFP2(normal 7), B-HCG <2, LDH 208( normal 118-220)

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